Get Paychex DP0002 2014

Direct Deposit Enrollment/Change Form Company Name Client Number Employee/Worker Name Employee/Worker Number EMPLOYEE/WORKER Retain a copy of this form for your records. Return the original to your employer. EMPLOYERS Return this form to your local Paychex office. For clients using on-line services please retain a of this document for your records. 00 Remainder of Net Pay One of the following is required to process this enrollment check one Voided check with name imprinted no starter checks Deposit slip only accepted if the verbiage ACH R/T appears before the routing number Bank letter or specification sheet the signature of your local bank representative MUST be included Other Bank Documentation from your Financial Institution If this box is checked the employer must sign this confirmation I confirm that the above named employee/worker has added or changed a bank account for direct deposit transactions processed by Paychex Inc. Employer Signature Date Certain accounts may have restrictions on deposits and withdrawals. Direct Deposit Enrollment/Change Form Company Name Client Number Employee/Worker Name Employee/Worker Number EMPLOYEE/WORKER Retain a copy of this form for your records. Return the original to your employer. EMPLOYERS Return this form to your local Paychex office. For clients using on-line services please retain a of this document for your records. copy COMPLETE TO ENROLL / ADD / CHANGE BANK ACCOUNTS PLEASE PRINT IN BLACK/BLUE INK ONLY Type of Account Checking Savings Routing/Transit Number Checking/Savings Account Number Financial Institution Bank Name I wish to deposit check one of Net Specific Dollar Amount. Check with your bank for more information specific to your account. COMPLETE IF CHANGING EXISTING DEPOSIT AMOUNTS PLEASE PRINT IN BLACK/BLUE INK ONLY Change My Deposit Amount to From to of Net From. 00 To. 00 PLEASE SIGN IN BLACK/BLUE INK ONLY I authorize my employer to deposit my wages/salary into the bank accounts specified above. I agree that direct deposit transactions I authorize comply with all applicable law. My signature below indicates that I am agreeing that I am either the accountholder or have the authority of the accountholder to authorize my employer to make direct deposits into the named account. Return the original to your employer. EMPLOYERS Return this form to your local Paychex office. For clients using on-line services please retain a of this document for your records. copy COMPLETE TO ENROLL / ADD / CHANGE BANK ACCOUNTS PLEASE PRINT IN BLACK/BLUE INK ONLY Type of Account Checking Savings Routing/Transit Number Checking/Savings Account Number Financial Institution Bank Name I wish to deposit check one of Net Specific Dollar Amount. Check with your bank for more information specific to your account. COMPLETE IF CHANGING EXISTING DEPOSIT AMOUNTS PLEASE PRINT IN BLACK/BLUE INK ONLY Change My Deposit Amount to From to of Net From. 00 To. 00 PLEASE SIGN IN BLACK/BLUE INK ONLY I authorize my employer to deposit my wages/salary into the bank accounts specified above. .